Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA.
Bioethics. 2022 Mar;36(3):267-273. doi: 10.1111/bioe.12992. Epub 2021 Dec 30.
The topic of Black mistrust of medical institutions and health care has received a great deal of attention over the course of the Covid-19 pandemic, especially with the arrival of vaccines and the emergence of a gap in vaccination rates by race. This article examines current discourses and debates over medical mistrust, and describes the limitations of the mistrust framework for identifying and addressing the institutional change necessary to remedy racial health inequities. As numerous observers have pointed out, the mistrust discourse largely places the burden of change on historically exploited and mistreated populations, rather than on the medical institutions that committed the violations and continue the mistreatment that are often identified as sources of mistrust. However, even the analytic shift to focus on the trustworthiness of institutions narrows the scope of the issue to the relationships of medical institutions to specific communities. While the mistrust literature has made important contributions to centering and valuing Black perspectives, this framework delimits the focus to Black perceptions and behaviors rather than on medical institutions and the health care system. Whereas the predominately white analytic lens of bioethics scholarship has centered Black populations by making them the subject of study, this article draws a distinction between simply analyzing, versus meaningfully centering and deriving an analysis from the perspective of marginalized populations within scholarship. This article suggests moving beyond the mistrust framework and the assumption of white normativity to conduct the type of institutional analysis necessary for addressing racial health inequities.
在新冠疫情期间，黑人对医疗机构和医疗保健的不信任问题引起了广泛关注，尤其是随着疫苗的出现以及不同种族之间的疫苗接种率差距的出现。本文探讨了当前对医疗不信任的论述和辩论，并描述了不信任框架在确定和解决纠正种族健康不平等所需的体制变革方面的局限性。正如许多观察家所指出的，不信任的论述在很大程度上将变革的负担放在了历史上被剥削和虐待的人群身上，而不是放在那些犯下侵犯行为并继续进行虐待的医疗机构身上，而这些医疗机构往往被认为是不信任的根源。然而，即使是将分析重点转移到关注机构的可靠性上，也将问题的范围缩小到了医疗机构与特定社区的关系上。尽管不信任文献对将黑人观点和价值观置于中心位置做出了重要贡献，但这一框架将重点局限于黑人的看法和行为，而不是医疗机构和医疗保健系统。虽然生物伦理奖学金的主要是白人的分析视角通过将黑人作为研究对象来关注黑人，但本文在分析中区分了简单地分析与从学术研究中边缘化群体的角度有意义地关注和得出分析的区别。本文建议超越不信任框架和白人规范的假设，进行必要的体制分析，以解决种族健康不平等问题。
